ACOG Committee Opinion No. 448: Menstrual Manipulation for Adolescents With Disabilities

Obstet Gynecol. 2009 Dec;114(6):1428-31. doi: 10.1097/AOG.0b013e3181c6f922.


Defining the reasons for intervention and the precise goal of treatment are the most critical issues regarding use of interventions to alter menstrual flow in adolescents with disabilities. Reasons for intervention may relate to abnormal uterine bleeding, hygiene, mood issues, fear of pregnancy, and acute onset of other medical conditions. Goals of treatment may include a decrease in the amount of bleeding, periodic amenorrhea, or treatment of symptoms, such as mood issues or dysmenorrhea. First-line treatment options should be safe, minimally invasive, and nonpermanent. Endometrial ablation has not been studied in adolescents, has not been studied longterm, is considered irreversible and, therefore, is not recommended in teenagers.

MeSH terms

  • Adolescent
  • Contraceptive Agents, Female / therapeutic use*
  • Disabled Persons*
  • Endometrial Ablation Techniques
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hysterectomy
  • Informed Consent
  • Menstruation Disturbances / drug therapy*
  • Menstruation Disturbances / surgery
  • Menstruation*
  • Parent-Child Relations
  • Physician-Patient Relations*


  • Contraceptive Agents, Female